Provider Demographics
NPI:1861543464
Name:SPADY, RICHARD DEAN (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:DEAN
Last Name:SPADY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:991 MEDICAL PARK DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MAYSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41056-8764
Mailing Address - Country:US
Mailing Address - Phone:606-759-9011
Mailing Address - Fax:606-759-0676
Practice Address - Street 1:991 MEDICAL PARK DR
Practice Address - Street 2:SUITE 201
Practice Address - City:MAYSVILLE
Practice Address - State:KY
Practice Address - Zip Code:41056-8764
Practice Address - Country:US
Practice Address - Phone:606-759-9011
Practice Address - Fax:606-759-0676
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01045146174400000X
IN01045146A208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200103270Medicaid
IN200103270Medicaid
INE25158Medicare UPIN